February 19, 2026
In response to the continuing state regulatory activity involving health plans and employer sponsored employee programs, we have attached a summary of these legislative updates.
Feel free to contact your Fedeli Group service team to address your regulatory compliance questions and concerns.
Alaska: Unemployment Benefits
On February 12, 2026, the Alaska Department of Labor and Workplace Development announced the expansion of Disaster Unemployment Assistance for Western Alaska. The basis for expanding the assistance was due to extreme weather conditions from October 8, 2025, through October 13, 2025. These weather conditions created hardships for the populations in the areas of the Lower Kuskokwim REAA, Lower Yukon REAA and Northwest Arctic Borough which were declared disaster areas.
Arkansas: Health Insurer Reporting
On February 3, 2026, the Arkansas Insurance Department published guidance to clarify annual reporting requirements for health insurers that work with Pharmacy Benefit Managers. State Rule 118 requires insurers to submit detailed pharmacy network adequacy data by March 1 each year. The data will detail the previous calendar year’s operations. The requirement to report this data will be due March 1, 2026, for data from 2025.
California: Workers’ Compensation
On January 29, 2026, the California Department of Industrial Relations (DIR) and the Division of Workers’ Compensation (DWC) issued a Progress Report on the DWC’s Independent Bill Review (IBR) program. The IBR is a billing dispute resolution process for medical treatment and medical-legal services provided to injured workers.
California: Workplace Notice
On January 30, 2026, the California Department of Industrial Relations issued a reminder to employers about the Workplace Know Your Rights Act. The Act which took effect on January 1, 2026, requires employers to annually provide workers with clear information about their workplace rights. The notice deadline is February 1st of each year and is to be provided to all workers, regardless of their immigration status and shared through common methods such as email, text message or in person, in languages normally used at the workplace.
Connecticut: Access Health CT – Premium Assistance
The Connecticut Insurance Department announced the availability Access Health CT – Premium assistance which is a one-year temporary aid program to provide financial assistance to residents facing higher health insurance premiums after enhanced federal tax credits expired at the end of last year. The program provides assistance for individuals and families enrolled in health plans through Access Health CT.
Delaware: Workers’ Compensation
On February 5, 2026, the Delaware Department of Insurance published Revised Foreign Insurers Bulletin 159 and Producer and Adjuster Bulletin 38 that enhanced guidance on payroll audits. The updated rules require carriers to include detailed calculations and supporting documentation to the respective audit bills along with detailing the payroll reviewed, class codes applied, adjustments made, and complete premium calculations (without disclosing employee personal information). Carriers with online portals shall make all audit records, billing notices, and correspondence digitally accessible.
Kentucky: Medicare
On February 2, 2026, the Kentucky Department of Insurance released its 2026 Medicare Supplement Guide.
Louisiana: Pharmacy Benefit Manager (PBM)
On February 13, 2026, the Louisiana Department of Insurance instructed PBMs to reimburse pharmacies at least $9.00 above the National Average Drug Acquisition Cost (NADAC) for a standard 30-day prescription supply. The $9.00 increase represents a combined markup and professional dispensing fee. The effective date for this new requirement is currently listed as March 1, 2026.
Maryland: ACA Rate Filings
On February 3, 2026, the Maryland Insurance Administration announced that additional time shall be provided to health insurers to file forms and rates for 2027 individual and small business health plans. The extension is being implemented as carriers are expected to experience “very challenging” circumstances meeting normal submission requirements without the federal Notice of Benefit and Payment Parameters for 2027. The revised timeline requires insurers that sell individual health plans to submit most policy forms by March 2, 2026, with rates due May 18, 2026. Small employer plan forms are scheduled to be due April 1, 2026, with rates following June 1, 2026. The state is implementing a staggered approach that permits carriers to initially file template documents, then provide the plan-specific cost-sharing details within 60 to 80 days after the federal parameters are released.
Individual and small employer dental plans being sold on the exchange must still meet the May 1, 2026, deadline for both forms and rates.
Maryland: Prescription Coverage
On January 29, 2026, the Maryland Insurance Administration announced the rescission of Bulletin 26-4. The rescission permits health issuers to return to their standard prescription refill schedules and coverage policies. The Insurance Commissioner has instructed all health insurers to waive time limits on prescription refills and to authorize payment for at least 30-day supplies of medications, regardless of when prescriptions had last been filled.
Massachusetts: Prior Authorization
On January 14, 2026, Massachusetts announced that the Massachusetts Division of Insurance will prohibit health insurers from requiring prior authorization for services that include emergency visits, primary care, chronic disease management, occupational and physical therapy and certain prescription drugs.
In addition, diabetic patients are no longer required to obtain insurance approval for devices, medications, or services related to their condition. A patient switching insurers midtreatment would have their existing authorizations honored for at least three months. Insurers are required to respond to urgent requests, such as for a multiple sclerosis patient seeking steroid injections during a relapse, within 24 hours.
Nevada: Medicare
The Nevada Division of Insurance has published its 2026 Medicare Supplement Insurance Premium Comparison Guide.
New York: Workers’ Compensation
On January 23, 2026, the New York State Workers’ Compensation Board published the updated mileage reimbursement rate of 72.5 cents per mile for injured workers who need to travel by personal vehicle for workers’ compensation related appointments. The rate is retroactive back to January 1, 2026.
New York: Health Provider Payment
On February 12, 2026, New York is requiring insurers to notify health providers of any potential fees associated with virtual credit cards or electronic payment methods, offer a fee-free alternative, and obtain the provider’s explicit consent before using fee-based payment methods. This new legislation removes a provision permitting insurers and providers to waive these protections through contract language and prohibits waivers in any contract “issued, renewed, modified, altered or amended” after the law takes effect.
New York: Paid Family Leave – Construction Workers
On February 12, 2026, New York is permitting construction workers to qualify for paid family leave if they have worked a normal work week for at least 26 of the last 39 weeks with any covered employer that is party to a union contract. Per the new regulations, workers shall remain eligible for benefits with their most recent employer before taking leave and may remain eligible even after layoffs if they return to work and meet the qualification criteria.
The new legislation also clarifies that construction workers may maintain their union health plan benefits during family leave, just as other employees maintain their employer provided health coverage under the federal FMLA law. This program is expected to become effective on January 1, 2027.
New York: Health Savings Account
On February 12, 2026, New York amended and delayed NY S.B. 6895 until Jan. 1, 2027. The original law’s design to require pre-deductible coverage for contraceptive services and prescription drug copay assistance in HSA-qualified high-deductible health plans, resulted in a direct conflict with the federal HSA law (26 U.S.C. § 223). The federal HSA law typically prohibits any pre-deductible coverage except IRS-defined preventive care, or the account loses its tax-advantaged status.
The new state legislation resolves this conflict by permitting state-mandated benefits to be subject to plan deductibles as necessary to comply with federal HSA eligibility. Preventive care as defined under 26 U.S.C. § 223(c)(2)(C) remains exempt from deductibles. To provide time for employers and insurers to restructure HSA plans to comply with the new legislation and to prepare communications to alert members about applicable benefit structure modifications, the legislation will apply to all policies issued, renewed, modified or amended on or after Jan. 1, 2027.
North Dakota: Dental Insurance
On January 29, 2026, the North Dakota Insurance & Securities Department published new loss ratio reporting requirements for dental insurers. Dental insurers are now required to submit loss ratio reports through the state’s electronic System for Electronic Rate and Form Filing by no later than April 30th of each year. Insurers must organize their submissions by market type, providing specific metrics including plan details, policyholder counts, member months as well as calculated dental loss ratios.
For the initial 2026 reporting year, insurers shall submit data covering both the 2024 and 2025 calendar years. In subsequent year’s submissions, insurers shall limit their report data to the calendar year preceding the April 30th deadline.
Oklahoma: Health Insurance Exchange
The Oklahoma Insurance Department (OID) announced that Oklahoma will transition from the federally facilitated HealthCare.gov platform to a State Based Exchange (SBE) format for the 2028 Open Enrollment Period. Consumers will continue to use HealthCare.gov to enroll in health plans for 2026 and 2027 coverage. As of November 2027, consumers will be able to utilize Oklahoma’s State Based Exchange to locate and enroll in their 2028 coverage year plan coverage needs.
Oregon: Workers’ Compensation
On February 11, 2026, the Oregon Workers’ Compensation Division published its updated list of registered vocational assistance counselors and providers as required by ORS 656.340(10).
Oregon: Disability Benefits
On January 29, 2026, the Oregon Workers’ Compensation Division published its updated guidance on how insurers are to calculate whether injured workers are unable to engage in “gainful occupation.” The newly published guidance provides a formula that factors in workers’ pre-injury wages and federal poverty guidelines. The factor approach may differ depending on when the injury occurred.
Puerto Rico: Health Insurance Coverage
On January 14, 2026, the Puerto Rico Office of the Commissioner of Insurance issued Circular Letter CC-2026-2053-D to amend Puerto Rico’s 2008 tobacco treatment protocol in order to require health insurers to report their medical coverage for smoking cessation services to the Department of Health’s Division of Prevention, Control of Tobacco and Oral Health. The report shall detail information about medications available to subscribers seeking treatment for tobacco use and dependence.
Puerto Rico: Paid Leave
On January 27, 2026, Puerto Rico declared a state of emergency due to an influenza epidemic in Puerto Rico.
As per the Puerto Rico Vacation and Sick Leave Act, non-exempt employees are entitled to a maximum of five additional paid working days of special emergency leave should the employee be impacted by the illness or epidemic that caused the state of emergency to be declared. To be eligible for the Act’s leave, the following conditions must be met:
Tennessee: Workers’ Compensation
The Tennessee Department of Commerce and Insurance (TDCI) announced that workers’ compensation insurance premiums will decline for most Tennessee businesses in 2026. On December 23, 2025, the TDCI Commissioner approved a 1.1% decrease in the assigned risk rate level and approved a 2% overall loss cost decrease for the voluntary market beginning March 1, 2026, for new and renewal policies.
Texas: Health Insurance Plans
The Texas Department of Insurance approved new regulatory changes to address billing disputes and emergency medical services.
Billing Disputes
Under the new rules, health plans and out-of-network providers must request mediation within 180 days of receiving the initial payment. This timeline includes cases where the payment is zero because charges were applied to a patient’s deductible.
Emergency Medical Services
While the new regulations permit political subdivisions that set ambulance rates in order to adjust them annually, a rate increase is capped at the lower of 2% (the current Medicare Ambulance Inflation Factor) or 10%.
Explanation of Benefits
Health plans are required to include specific dispute resolution language in EOBs sent to providers and clearly identify plan types (“ERISA Opt-In,” “Higher Ed Plan”) to facilitate proper dispute filing.
Virginia: Workers’ Compensation
The Virginia Workers’ Compensation Commission updated its Award Agreement and Termination of Wage Loss Award forms.
Washington: Paid Sick Leave
The Washington State Department of Labor and Industries announced updates to the workplace policies governing paid sick leave. The new regulations include:
Washington: Personnel Records
The Washington State Department of Labor and Industries announced updates to workplace policies regarding personnel files. The new regulations include:
West Virginia: Prescription Drug Rebates
On February 2, 2026, the West Virginia Offices of the Insurance Commissioner amended the Pharmacy Audit Integrity Act. The Act’s amendment requires Pharmacy Benefit Managers to pass 100% of drug manufacturer rebates to the consumers as of the point of sale. If a rebate exceeds a customer’s out-of-pocket cost limit, the outstanding amount shall go to the insurers to reduce premiums.
DISCLAIMER
The information provided by The Fedeli Group’s Compliance Alert is not intended to be, nor should it be, interpreted as conferring legal advice to the reader of the Compliance Alert. The Fedeli Group Compliance Alerts are designed specifically and solely for informational purposes. Should the reader have any legal questions or concerns after reading this Compliance Alert, it is recommended that the reader seek counsel for a formal opinion.
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